Neoadjuvant Treatment Mitigates the Survival Impact of Major Complications after Resection of Pancreatic Adenocarcinoma

Postoperative major complications (PMCs) may prevent multimodality therapy (MMT) for pancreatic ductal adenocarcinoma (PDAC) patients by delaying adjuvant (AT) following surgery-first (SF) sequencing. We hypothesized that neoadjuvant (NT) mitigates the detrimental effect of PMCs on outcomes resected patients. Characteristics consecutive PDAC 7/2011-10/2018 were abstracted from a prospective database. defined at 90-days as ACCORDION Grade ≥3. Overall survival (OS) was compared between with and without PMCs. Of 373 patients, most underwent NT (75%). occurred in 22% SF 20% (p=0.71). Most went to receive some form AT (90% vs. 70% NT,p< 0.001). Median OS 46 36 months (p=0.037). negatively impacted OS, median 59 NT(-)PMC, 34 NT(+)PMC, 45 SF(-)PMC, 20 SF(+)PMC (p< 0.001;Fig. 1A). There trend toward worse NT(+)PMCs (p=0.06, Figure 1B). not independent predictors However, after adjustment clinical classification, treatment sequencing, tumor size, margin status, independently-associated (HR-1.60,p=0.010) among all along perineural invasion (HR-1.83, p=0.024), nodal positivity (HR-2.1,p< 0.001), (HR-0.69,p=0.039). The deleterious effects be mitigated NT. sequencing should routinely considered given significant risk post-pancreatectomy morbidity.